A village would be nice but …: It takes a long-acting contraceptive to prevent repeat adolescent pregnancies

Abstract

Objective: To determine which components of a comprehensive, multidisciplinary, adolescent-oriented maternity program help teenage mothers delay subsequent pregnancies. Design/ Setting/ Patients: A cohort of 373 participants in a comprehensive, multidisciplinary, adolescent-oriented maternity program was studied. Intervention: The program was designed to prevent rapid subsequent pregnancies directly by simplifying access to contraceptives and indirectly by discouraging school drop-out and encouraging the pursuit of careers incompatible with closely spaced childbearing. Parents and children were seen together; nine visits were scheduled during the first postpartum year and four visits during the second year. Main Outcome Measure: Repeat adolescent pregnancy. Results: The repeat pregnancy rate was 14% at 1 year and 35% at 2 years. Teenage mothers who became pregnant exhibited significantly more repeat pregnancy risk factors but were as compliant with clinic visits as their nonpregnant peers. The contraceptive choices the teenagers made during the puerperium had the most profound effect on their subsequent fertility. A logistic regression analysis identified failure to use Norplant during the puerperium as the strongest predictor of repeat pregnancy during the first 2 postpartum years (relative risk [RR]=8.89; 95% confidence interval [CI]=2.80–28.50). Exhibiting nine or more repeat pregnancy risk factors (RR=2.37; 95% CI=1.38–4.06) and not using Depo-Provera during the puerperium (RR=2.30; 95% CI=1.60–3.29) also predicted repeat conception, but clinic visits and return to school postpartum did not. Conclusions: Using a long-acting hormonal contraceptive during the puerperium was associated with pregnancy prevention during the first 2 postpartum years, but frequent clinic visits, contact with supportive healthcare and social service providers, and return to school were not.